Provider Demographics
NPI:1508973223
Name:ALLEN, DOMINIQUE W (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:W
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:SUITE 501
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6831
Practice Address - Country:US
Practice Address - Phone:410-938-8960
Practice Address - Fax:410-583-9770
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-06-20
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Provider Licenses
StateLicense IDTaxonomies
MDD0053109207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD994LMedicare UPIN
MD219102YYKMedicare PIN